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Measurement

Finance

Global funding for family planning is a stool with three legs: domestic government expenditures, international donor contributions, and consumer spending.

Domestic government spending is the mainstay of a country’s family planning program, providing a budgeted flow of funds for services and staff. Funding from international donors provides the fiscal headroom to expand and strengthen the program, secure the supply of commodities, and incorporate relatively high-priced contraceptives into the method mix. Out-of-pocket spending by consumers — for commodities and services purchased in the private sector or service fees in the public sector — facilitates customer segmentation and a total market approach to family planning.  

The importance of each “leg” varies significantly across countries. Family planning programs in some countries are very donor dependent, while others are largely funded by the government and consumers. But from a global perspective, all three types of funding are essential for progress in strengthening and expanding rights-based family planning.  

FP2030 builds on the efforts of the FP2020 partnership to track these resource flows across the family planning sector. We are joined in this work by several other partners who also track aspects of SRH spending — not just family planning — within the larger universe of low-income, lower-middle income, and upper-middle income countries. No one partner has the resources to map the entire landscape; together our reports provide a composite look at all the available data.  

Tracking the Financial Landscape

FP2030 is one of several data partners who track resource flows and expenditures for sexual and reproductive health. The reports overlaps in scope and compliment each other in focus and depth.

LEAP Report, RHSC: https://leap.rhsupplies.org/  
CSI Survey, USAID GHSC: https://www.ghsupplychain.org/csi-dashboard/2021  
Family Planning Market Report, RHSC & CHAI: https://www.rhsupplies.org/uploads/tx_rhscpublications/Family-Planning-Market-Report.pdf  
Donors Delivering for SRHR Report, DSW: https://donorsdelivering.report/  

For 2022, FP2030 estimates total expenditures on family planning at US$4.0 billion across all low-income and lower middle-income countries. International donors contributed an estimated US$1.64 billion (including US$1.35 billion from donor governments), domestic governments an estimated US$1.68 billion, and consumers an estimated US$710 million. (Each of these estimates is explained in more detail in subsections below.)  

The domestic government figure is on par with our last two estimates for domestic expenditures: US$1.6 billion in 2019 and US$1.73 billion in 2021. Fluctuations in this total from year to year should not be interpreted as a trend; domestic expenditure estimates are still relatively new and reflect the evolving and ever-sharpening nature of the methodology, as more and more countries report their expenditure data.  

The alarming data point this year is the decline in donor government contributions, which does look like a trend. The Kaiser Family Foundation (KFF) has tracked donor government expenditures every year since 2012 using the same methodology. The estimated total for 2022 is almost 10% below the prior year’s level and almost 15% below the peak level in 2019. Donor governments are now providing a level of funding on par with what they were providing in 2015.  

Yet, as noted earlier in this report, the population of women of reproductive age is now 20% larger than it was at the outset of this partnership in 2012.  

If donor funding continues to stagnate or shrink, it could imperil the achievement of country goals for family planning as well as the Sustainable Development Goals. Domestic governments, which collectively already shoulder the largest portion of total family planning expenditures, may not be able to meet the shortfall. Consumers in these countries may be forced to spend more money out-of-pocket or forego services entirely. Expensive contraceptive methods that depend on donor support, such as implants, may become less available.  

These factors should be borne in mind as countries and their donor partners plan for the future. What level of expenditure is needed to serve a growing population of women who want access to a wide range of contraceptive methods, both today and in years to come? What level is needed to expand family planning services to those who have been left behind? Countries, donors, and the global family planning community will need to think in terms of long-range funding strategies that make the most of domestic resources as well as donor contributions.   

International Donor Funding

We estimate that international donors spent US$1.64 billion on family planning in 2022. This includes contributions from donor governments as well as NGOs and private foundations. The lion’s share (US$1.35 billion) is from donor governments, as reported by the Kaiser Family Foundation (KFF); see below for their analysisOther international donors (NGOs and private foundations) contributed an estimated US$360 million in 2022; see below for further discussion.

bullhorn

Family planning funding from donor governments was US$1.35 in 2022. This represents a decline of US$129 million compared to 2021 and marks the lowest level of funding since 2016.

Donor Government Funding for Family Planning In 2022: KFF Summary Analysis 

KFF has been collecting and analyzing donor government funding for family planning (FP) on an annual basis since the London Summit on Family Planning in 2012. This year’s analysis assesses funding in 2022 as well as trends over time. Totals presented include both bilateral funding specifically for FP, as well as the estimated share of donor government contributions to UNFPA’s core resources that are used for FP. It is based on analysis of data from the 32 donor government members of the Organisation for Economic Co-operation and Development (OECD) Development Assistance Committee (DAC) in 2022 who had reported Official Development Assistance (ODA). Data were collected directly from 9 of these governments, who account for 97% of all bilateral donor government funding for family planning; data for the remaining donors were obtained from the OECD Creditor Reporting System (CRS).  

Donor government total disbursements for family planning

Family planning funding from donor governments was US$1.35 in 2022. This represents a decline of US$129 million compared to 2021 (US$1.48 billion; see Figure 1) and marks the lowest level of funding since 2016 (US$1.31 billion).19 While some of the decline was due to actual decreases by donor governments, a significant share can be attributed to the rise of the US dollar globally.20
19.
FP totals are different from those reported last year due to updated data received after the 2022 report was published as well as a change in methodology that incorporates the FP-adjusted share of core contributions to UNFPA (see Methodological Note in the Technical Appendix). Donor amounts do not exactly sum up to total amounts due to rounding.
20.
In most cases, donor governments provide funding data in their currency of origin, which are converted to US dollars for this report (see Methodological Note in the Technical Appendix). The rise in value of the US dollar globally in 2022 resulted in exchange rate fluctuations that exacerbated any changes in FP funding between 2021 and 2022 when converting a donor government’s totals from currency of origin to US dollars.

FIGURE 14

Donor Government Bilateral Disbursements for Family Planning, 2012–2022

Individual donor government disbursements

Funding from six donor governments (Australia, Canada, Denmark, Germany, Sweden, and the U.K.) decreased in 2022. Some of these declines were due to budgetary decisions associated with the humanitarian response to the conflict in Ukraine, while some followed increases in 2021 and represented a return to prior year amounts.21 These trends were the same after accounting for exchange rate fluctuations, though the decreases were smaller.  
21.
Denmark and Sweden attributed their declines to budgetary needs associated with the humanitarian response to the conflict in Ukraine. Declines by Australia, Germany, and Sweden followed significant increases in 2021 and returned funding levels approximately to prior year amounts.

tABLE 6

Donor Government Bilateral Disbursements for Family Planning, 2012-2022* (in current US$, millions)

COUNTRY

2012

2013

2014

2015

2016

2017

2018

2019

2020

2021

2022

Australia

Canada

Denmark

Germany

Netherlands

Norway

Sweden

United Kingdom

United States

Other DAC Countries

TOTAL

$46.0

$42.4

$29.2

$14.6

$26.2

$27.5

$23.3

$25.7

 $25.0

$49.5

$44.8

$48.6

$50.9

$45.4

$46.0

$72.3

$83.6

$91.2

$96.1

$99.9

$21.3

$27.9

$36.6

$35.6

$35.9

$44.7

$44.0

$32.70

$24.9

$26.5

$51.5

$42.7

$35.9

$38.1

$42.3

$43.6

$55.1

$49.9

$46.9

$70.1

$114.6

$163.5

$172.6

$173.4

$190.4

$207.0

$221.2

$209.1

$208.9

$193.7

$14.4

$33.6

$33.6

$18.7

$14.4

$15.9

$22.4

$25.3

$20.6

$19.7

$53.6

$62.7

$83.3

$76.9

$103.5

$126.4

$119.4

$122.8

$141.0

$185.5

$258.8

$311.1

$333.8

$275.8

$209.5

$287.0

$288.3

$387.4

$275.6

$207.7

$585.5

$584.7

$585.1

$585.0

$582.5

$600.5

$592.5

$592.5

$592.5

$579.2

$79.1

$87.3

$102.3

$96.7

$57.4

$50.3

$59.1

$38.4

$49.6

$47.4

$1,269.5

$1,404.8

$1,463.2

$1,360.2

$1,308.2

$1,475.0

$1,508.9

$1,575.0

$1,481.1

$1,479.3

$36.0

$88.3

$18.1

$36.6

$217.4

$31.4

$121.3

$174.7

$582.9

$43.2

$1,349.9

Donor governments as a share of total disbursements

The US continued to be the largest donor to family planning in 2022, accounting for 43% (US$582.9 million) of total funding from governments, followed by the Netherlands (US$217.4 million, 16%), the U.K. (US$174.7 million, 13%), Sweden (US$121.3 million, 9%) and Canada (US$88.3 million, 7%).  

The vast majority of family planning funding is provided bilaterally (US$1.3 billion or 96%). The remainder — US$50 million (4%) — is in the form of multilateral contributions to UNFPA’s core resources, adjusted for an estimated FP share. 

FIGURE 15

International Family Planning Assistance: Donor Governments as a Share of Bilateral Disbursements, 2022

Note: figures based on Kaiser Family Foundation analysis of donor government funding for family planning

Other International Donors

While the bulk of donor funding for family planning is captured by the KFF estimates, some contributions by private foundations and NGOs lie outside these reporting channels. The Institute for Health Metrics and Evaluation (IHME) collects data from several sources, including the OECD-DAC CRS, World Bank, regional development banks, USAID-financed NGOs, and UN agencies, to identify health spending by international donors.22 

IHME estimates that in 2022, foundations and NGOs provided US$360 million in funding for family planning that is not included in the KFF estimate. It is important to note, however, that this still does not provide a complete picture of donor funding. Anonymous donors are not included in these estimates, nor is it possible to ascertain how much funding for family planning is flowing through the Global Financing Facility. These are areas where additional methods of estimation may need to be developed.  

22.
Keyword searches of project descriptions are used to distinguish family planning funding from other types of Donor Assistance for Health (DAH). Estimates include funding from bilateral donors as well as foundations and NGOs.

Domestic Government Expenditures

Domestic governments spent an estimated US$1.68 billion on family planning in 2022. Domestic expenditures are defined as all government expenditures that support family planning, including commodity purchases, demand creation campaigns, investments in training and research, and service delivery.   

This is our sixth year of reporting domestic expenditures at the country level, with the number of countries for which estimates are available increasing each year. This year’s table includes estimates for 61 low- and lower-middle income countries, amounting to US$1.6 billion in spending. The largest amounts are reported by populous countries in Asia that fund much of their own program. India, the Philippines, Indonesia, Bangladesh and Pakistan together account for about 76% of the total. Government expenditure per modern method user ranges from nearly zero to US$50, with an average of US$5 per user. Reporting countries account for 95% of modern method users in all low-income and lower middle-income countries. Adjusting for the missing countries raises the estimated domestic government expenditures to US$1.68 billion.  

The latest estimate of expenditures is 3% lower than reported last year. This should not be interpreted as a trend, however, since the data set has changed each year and there are large fluctuations in country spending. The new estimate adds four countries (Cambodia, Eswatini, Palestine, and Tunisia) totaling nearly US$39 million, but there were large declines in spending in Bangladesh (from US$230 million to US$187 million) and Indonesia (from US$355 million to US$251 million) that were only partially offset by increases in Pakistan (US$130 million to US$171 million) and the Philippines (US$260 million to US$294 million).  

tABLE 7

Domestic Government Expenditures of Family Planning

COUNTRY

2016

2017

2018

2019

2020

2021

2022

Source

Afghanistan

Bangladesh

Benin

Bhutan

Bolivia

Burkina Faso

Burundi

Cambodia

Cameroon

Chad

Comoros

Congo (Brazzaville)

Congo, DR

Côte d’Ivoire

Djibouti

Egypt

Eswatini

Ethiopia

Gambia

Ghana

Guinea

Guinea-Bissau

Honduras 

India

Indonesia

Kenya

Kyrgyzstan

Lao PDR

Lesotho

Liberia

Madagascar

Malawi

Mali

Mauritania

Mozambique

Myanmar

Nepal

Nicaragua

Niger

Nigeria

Pakistan

Palestinian Territory

Papua New Guinea

Philippines

Rwanda

Sao Tome and Principe

Senegal

Sierra Leone

Somalia

South Sudan

Sri Lanka

Tajikistan

Tanzania

Timor-Leste

Togo

Tunisia

Uganda

Uzbekistan

Viet Nam

Zambia

Zimbabwe

$496,943

$1,451,214

$46,838

$995,876

UNFPA

$230,240,000

$202,016,765

$186,593,474

FPSA

$2,201,743

$3,443,101

$3,480,585

FPSA

$7,960,108

$3,241,442

FPSA

$9,244,791

$10,548,488

FPSA

$1,889,101

$1,756,825

FPSA

$3,030,699

$2,502,913

$3,051,440

FPSA

$5,128,710

$5,577,714

$5,678,687

WHO

$135,702

$639,234

$819,419

FPSA

$4,013,810

$5,814,595

$6,159,292

FPSA

$2,318,307

$2,929,995

$3,662,714

$4,050,173.4

WHO

$4,575,746

$6,422,777

FPSA

$9,894,513

$11,451,878

$12,391,825

FPSA

$26,620,641

$35,711,413

$34,082,709

FPSA

$67,624

$89,456

$100,241

FPSA

$137,710,916

$8,605,751

UNFPA

$1,770,636

$1,492,055

FPSA

$6,441,333

$10,638,389

FPSA

$656,698

$525,126

$774,099

FPSA

$14,459,321

$5,083,393

FPSA

$3,975,186

$2,939,094

$13,946,324

FPSA

$223,361

$377,490

FPSA

$2,469,404

UNFPA

$227,181,172

$377,827,263

$257,300,783

$314,163,648

Govt

$335,471,125

$251,320,006

FPSA

$34,450,000

$34,443,510

$32,108,971

FPSA

$12,629,754

$12,656,967

$17,255,889

FPSA

$1,051,938

$754,082

$587,676

FPSA

$1,707,490

$1,191,180

$1,283,834

FPSA

$1,699,237

$7,769,268

FPSA

$1,569,686

$3,405,906

$2,931,085

FPSA

$3,281,256

$2,669,345

$3,733,259

FPSA

$5,132,920

$10,148,634

$9,508,581

FPSA

$448,603

$544,628

FPSA

$3,492,581

$3,459,445

FPSA

$6,277,150

FPSA

$5,068,272

$5,267,280

$4,886,554

FPSA

$1,402,624

$1,088,820

UNFPA

$1,181,061

$6,456,017

$3,949,117

FPSA

$9,544,913

$1,670,142

$7,423,097

$10,299,861

$8,359,745.18

$30,247,669

WHO

$130,971,130

$172,057,195

FPSA

$2,053,290

$2,178,994

FPSA

$1,767,979

$177,188

$156,754

UNFPA

$263,004,828

$260,171,718

$294,435,549

FPSA

$3,650,132

$4,118,124

FPSA

$350,473

$288,210

$246,178

FPSA

$4,265,521

$7,644,776

$13,538,312

FPSA

$1,305,108

$272,796

$347,391

FPSA

$14,080

$34,904

FPSA

$305,037

$435,053

FPSA

$13,590,842

$14,229,196

$15,375,538

FPSA

$1,857,052

$1,948,745

FPSA

$466,642

$2,549,106

$2,360,190

FPSA

$7,183,920

$535,508

$880,931

FPSA

$3,523,364

$4,454,808

$8,496,575

FPSA

$31,243,442

$32,223,019

$28,255,618

FPSA

$728,510

FPSA

$6,963,527

$4,459,734

$3,900,794

FPSA

$18,965,068

$18,019,222

$16,224,048

FPSA

$50,785,986

$41,560,937

FPSA

$5,507,599

$17,928,498

$8,975,302

FPSA

This table represents the total annual public sector recurrent expenditures on family planning. This includes expenditures by all levels of government and trends since 2016.

FPSA: Family Planning Spending Assessment
UNFPA: United Nations Population Fund
WHO: World Health Organization System of Health Accounts

Decentralized spending by national governments

In many countries government spending on family planning is decentralized, with some amounts coming from national budgets and some from sub-national government bodies. Thus there is interest in understanding how decentralized government entities—such as provinces, states, local government administrations/units and municipal governments, districts, and even facilities—might increase their funding for health programs and for family planning. Since 2017, Track20 has attempted to estimate the contribution of decentralized funding to total domestic funding as part of its Family Planning Spending Assessments (FPSAs). In that year Kenya reported decentralized funding from its 47 counties for 2014-2015.  

Table 8 lists the most recent data (from 2021 and 2022) for countries whose FPSA showed decentralized funding. The results indicate various levels of decentralized funding compared to central government funding. In Pakistan the ratio of decentralized funding is very high, with 98% of total FP expenditures coming from the provinces. In Kenya, the counties accounted for 85% of total family planning expenditures. The Philippines data show that decentralized funding amounted to 68% of total family planning expenditures, with the majority coming from Local Government Entities. 

tABLE 8

Sources of Family Planning Expenditures (in US dollars)

Total from all Financing Sources 

Total Central Government 

 Total Decentralized

Percent Decentralized 

Bolivia 2022

$10,548,488 

$8,372,523 

$2,175,965 

21%

Indonesia 2020 

$355,371,125 

$352,986,737

$2,469,294 

1%

Kenya 2021

$32,108,972

$4,937,874

$27,171,098 

85%

Mali 2021 

$10,148,634

$10,134,255

$14,378

0.1%

Nepal 2021 

$5,267,280

$4,968,612

$298,668

6% 

Pakistan 2021

$172,057,195

$4,800,274

$167,256,921

97%

Philippines

$294,435,549

$64,775,821

$229,659,728

78%

Somalia 2022 

$34,904

$17,584

$17,320

50%

Tanzania 2022 

$2,360,190

$1,948,607

$411,583

16%

Uzbekistan 2022

$3,900,794

$3,465,000

$435,280

11%

Vietnam 2022 

$16,224,048

$3,510,864

$12,713,184

78%

While the number of countries showing decentralized funding is relatively small (compared to the yearly average of 42 countries for which FPSAs were conducted in 2021 and 2022), there are at least three factors at work: 

  • The funding amounts are often small and hard to capture.  
  • In some countries, such as India, we know that significant funding is provided by subnational governments, but it is difficult to separate family planning from other health expenditures. 
  • In many countries, potential sources of decentralized funding are not invested in health/FP and contribute to other government sectors instead. 

Discussions in Francophone West Africa by Track20 staff revealed that many managers did not know if decentralized funding existed in their countries. Track20 is currently working with Nigeria to include the expenditures financed by the 37 Nigerian States.    

See the Technical Appendix for methodologies. 

Consumer out-of-pocket expenditures

Consumers spent an estimated US$710 million on family planning in 2022. This figure is based on the Landscape & Projection of Reproductive Health Supply Needs (LEAP) Report, produced by the Reproductive Health Supplies Coalition and Avenir Health. The LEAP Report estimates out-of-pocket expenditures on contraceptives based on the number of modern method users (from Track20 and the UN Population Division), method mix, price points, and the percentage of users obtaining services from the private sector (from DHS, MICS, and other national surveys). 

Technical Appendix

KFF Analysis

Family planning totals include bilateral funding as well as an FP-adjusted share of donor government contributions to UNFPA’s core resources. Bilateral funding represents amounts specifically designated by donor governments for family planning as defined by the OECD DAC and includes standalone family planning projects, family planning-specific contributions to multilateral organizations (e.g., contributions to UNFPA Supplies), and, in some cases, projects that include family planning within broader reproductive health activities.  

UNFPA’s core resources are meant to be used for both programmatic activities (family planning, population and development, HIV/AIDS, gender, and sexual and reproductive health and rights) as well as operational support. Donor government contributions to UNFPA’s core resources were adjusted to reflect the share of core resources supporting FP activities in a given year based on information from UNFPA. For instance, in 2022 UNFPA reported expenditures totaling US$532 million from core resources, including US$63 million for family planning activities, which results in an estimated 12% of a donor government’s core contribution in 2022 being included in its total funding for FP.23  

With some exceptions, data represent “disbursements,” which are defined as the actual release of funds to, or the purchase of goods or services for, a recipient. They were obtained through direct communication with donor governments, analysis of raw primary data, and the OECD CRS. UNFPA funding data were obtained from Executive Board documents and direct communications.  

For the US, funding represents final, Congressional appropriations (firm commitments that will be spent), rather than disbursements, which can fluctuate from year-to-year due to the unique nature of the US budget process (unlike most other donors, US foreign assistance funding may be disbursed over a multi-year period).  

In some cases it is difficult to disaggregate bilateral family planning funding from broader population, reproductive and maternal health totals, and the two are sometimes represented as integrated totals. In addition, family-planning-related activities funded in the context of other official development assistance sectors (e.g., humanitarian assistance, education, civil society) have remained largely unidentified. For the purpose of this analysis, we worked closely with the largest donors to family planning to identify such cross-sectoral family-planning-specific funding where possible (see table notes).     

Funding data are collected from donor governments in their currency of origin and converted to US dollars using exchange rate data from the OECD DAC and US Federal Reserve. Exchange rates for 2022 were applied to 2021 totals to assess the effect of currency fluctuations on overall funding levels between 2021-2022. Totals have not been adjusted for inflation. For data in the currency of the donor country, please contact the researchers. 

Domestic Government Expenditures

The expenditures reported come from three different sources:   

WHO/SHA. WHO has been implementing data collection on health expenditures under the System of Health Accounts (SHA) 2011 for several years as part of a joint effort with the Organization for Economic Co-operation and Development (OECD) and Eurostat. Government approved estimates are published on the WHO Global Health Expenditure Database. These data include directly measured expenditures by year, when available, or estimates based on trends from measurements in previous years.  

FPSA (Family Planning Spending Assessment). Track20 collects data on FP expenditures in low- and middle-income countries using a modified version of the National HIV/AIDS Spending Assessment (NASA) that focuses strictly on family planning. These analyses collect information from the main funders and implementing organizations to describe sources and uses of funds. Results are disseminated to governments and other stakeholders. The FPSA methods were first tested in Kenya with 2017 data and have now been extended to 48 countries with estimates of FP expenditures from government.     

UNFPA. UNFPA and NIDI (Netherlands Interdisciplinary Demographic Institute) tracked domestic government expenditures for family planning from 2014 to 2019. NIDI worked with national UNFPA offices to engage local consultants to review records and interview government officials. Results were checked for completeness and quality by NIDI. Final results were approved for release by the organizations contributing data and, in most cases, by appropriate government agencies. 

23.
In 2022, UNFPA spent approximately US$342 million (28% of UNFPA’s total programme expenses) on family planning activities (US$63 million from core resources and US$279 million from non-core resources). The total amount provided by UNFPA in 2022 includes funding exclusively designated for family-planning-specific activities, including enabling environments, provision of contraceptives and related supplies, and family planning systems strengthening. In contrast to previous years, this total excludes funding allocated to activities with an indirect impact on family planning outcomes.

PHOTO BY Jonathan Torgovnik/Getty Images/Images of Empowerment